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Risks of not doing fusion with a very thin degenerated disc?

mchell6789mmchell6789 Posts: 15
edited 06/11/2012 - 8:59 AM in Back Surgery and Neck Surgery
So I have had two microdiscectomies. The last one back in 2008. Haven't been doing too bad since then. All of my symptoms never competely went away but I actually was able to go bike riding 20 miles last summer. I did some other things like raking thatch out of my yard that herniated my disc again. (I think that was what did it) Just got done with a medrol pack. Hoping my body resorbs the herniation like it did the last time.

My question is that my disc is looking dangerously thin now. It's all black on the MRI and looks like it's bulging out on many sides not just where the herniation is. The radiology report only mentions how thin it is and the herniation. My surgeon has not seen it. I am trying to decide if I want to go in to see my surgeon and see if he will do a fusion. I am concered about what my risks are if I do not do the fusion since the disc is getting so thin and causing back pain. Can it cause damage to other things like the facet joints?

I have this delema because I'm really not in extreme pain but I can't sit for long periods of time. And I also am supposed to watch my grandbaby coming up in a few months and need to be able to be in shape for that. OH what to do. Backs are so frustrating. It would just be 6 hours a day four days a week watching the baby. I'll be putting myself at risk with that I think too. Going to try to be very careful.


  • Are the discs above the L5/S1 in good shape? If so, I think definitely you should go for the fusion. I've heard that many people who have one level fusions at L5/S1 have great results. I have a fusion at L4/L5, and I don't feel any change in my flexibility, and I think there's even less risk of that at your level. My fusion wasn't successful because the discs above and below it are bad too - so the fusion just puts more stress on them. Good luck!!
  • I worry about the same thing, my L5-S1 has degenerated I would guess about 50-60% maybe, the tip of my L5 vertebrae looks like its about 4 millimeters from touching the L4 vertebrae through the disc.
    I've had a lil bit of instability in the area and I think some of the weight and stress gets transfered to the facet joints. Thats just my guess tho, all the docs ive asked about this dont say anything.
  • Yes my discs above the L5-S1 are in great shape. Very thick and look totally normal. No other disc problems. It's just the L5-S1 that is bad. Yeah that's what I'm worried about that it's going to start putting pressure on the facet joints. It maybe is already I don't know the symptoms of that. I would think the radiologist would have mentioned that in the report though.

    Right now I just have a small herniation that is displacing my sciatic nerve 3mm. Most of the pain is in my back with that. I have been doing physical therapy excercises since 2008 and stretches along with that that have kept the sciatic nerve from becoming stuck in there so it moves through the area I can feel it when I do stretches. So I think that has helped keep my symptoms from disabling me. Everything I do is careful and I try to keep proper form.

    How long does it take to recover from a one level L5-S1 fusion? I know my back will never be new again but I'd like to be able to watch the baby. I have two grandbabies on the way. One is due in July.
  • And what happens when you get to be bone on bone? Is is it horrible pain that drops you to the ground? Or limited range of motion? I'm actually surprised I'm not in more pain looking at the MRI. But I want to avoid that pain that drops you like I had before.

    My surgeon refused to do the fusion back in 2008. He's supposed to be the best around here and my husband works with a couple people who swear by him. One of the guys had gone to a different surgeon and was still having a lot of pain but as soon as this guy worked on him he felt so much better. So I want the surgeon I have been going to to do the fusion. I think I'll set up an appointment for after the baby shower coming up here in a little over a week and see what he says.
  • Oftentimes (from what I understand, and I could be wrong), when you get to bone-on-bone, you tend to get a natural fusion going. If your disc isn't pressing on nerves or causing you great difficulties, I'd forego the fusion surgery. Trust me, I've had three levels done. Spent nine hours in surgery the first day, lost lots of blood, had to stay, get more units of blood and go back to surgery from the front four days later. The recovery was sheer hell, but my reduction in pain has been worth it. I could barely walk before the surgery. If you don't have a lot of arthritis or spondylolisthesis, you don't really have the risk of your spine sliding out of place, etc.

    Now, on the other hand, if you continue to do things like raking, etc., you do risk reinjuring your spine. I pay my niece to come and do my yard work for me now. Vacuuming is done by walking slowly along beside the vacuum -- not by pushing it back and forth. You have to be careful!!

    Best of luck.
    3 level spinal fusion, L3/4, L4/5, L5/S1, November 2008. Stiff, but I can walk.
  • Thanks for the reminder I do need to stop doing things like raking. Generally when I did rake last year I did it without twisting at all. But that one day I really got into trying to remove the thatch and I'm sure that was bad. I just need to hire people to do that kind of thing. I have to remember to be strong when telling people no also.

    So often people try to get me to do things that I should not be doing. Like just two days ago when planning the baby shower someone trying to get me to help move large tables saying if the legs fold then we can just roll them. I said I am NOT moving tables. I have found that to be one of the biggest things is knowing when to say no I can not do that and standing up for yourself. People who have never dealt with this do not know what it's like.
  • I didn't read all the responses but if you are generally okay, then why opt for a fusion?

    From what I'm reading you want to have a fusion as prevention but I'm not clear why.

    I have very little disc at L5S1 (2 MDs) and just recently went for another MRI. The disc is lousy. The one above it is not super but holding steady.

    My surgeon said I could lose more disc and probably wouldn't notice but that I could also fuse naturally over time. Remember, MRI is only part of what the doctor considers before recommending treatment.

    As for your grand baby, very exciting! Even with a fusion, you will always need to be careful lifting.

  • Well I have had a lot of back pain recently. That's why I had the medrol pack. Which has really helped. My biggest issue though is sitting for long periods of time. At Christmas we were at the in laws for 5 hours and I was laying on the floor by the end because of the sciatic nerve pain. I don't normally have a lot of nerve pain unless I sit for a long time. I don't know if a fusion would help that though. That's why I'm here to find out some of these things. Sometimes just sitting for a couple hours really makes my nerves hurt.

    So basically I have spent the last 4 years avoiding sitting for any longer then an hour. I'm lucky I don't have to work because I'd never be able to do what I was doing before with sitting all day. That's why I am considering fusion. But if my nerves arn't being compressed and fusion can happen on it's own that's an option too that I was not aware of. It would just be nice to be able to go on trips where a lot of sitting is involved. I have friends who just went on a 14 hour car trip and I could never do that with my sitting limitations.

    And thank you I am very excited about the grandbabies :)
  • A natural fusion of two vertatrae? Is that really possible? I would think that if the vertebrae touch each other It would be extreemely painful, Wouldn't it feel similar to a broken bone grinding under weight?
    I mean the vertebrae's are the main weight bearing structure.
  • I would think it would be very painful. I guess each situation is different. I searched on the board and the web after hearing about this and it seems some doctors even remove the disc material and just leave the disc and wait to see if it fuses naturally. I was wondering about the stability of the spine in this situation also.
  • As ZO6 recommended, make an appointment and see your surgeon. Fusion is a big surgery with a long recovery time, and you'll always have to be careful.

    As your discs above L5-S1 are good, then fusion could help you, but that'll be for you and your surgeon to decide on.

    I had L4-5 fused a couple of years ago, but the levels either side are a problem and I mainly have pain from L5-S1. At the time, the surgeon didn't want to fuse it, so it's been a wait and see if I can cope situation. I have to be careful with some activities and sitting and standing gives me the most pain. My fusion was successful and I don't have that excruciating 24/7 nerve pain, so I'm able to enjoy life with help from medication, walking and moving about.

    It normally takes up to 6 months to fuse and then another 6-12 months for it to become strong. It's a gradual healing process. The first month is not too good, but for me, medication helped. It took 6-7 months for the post-surgery back ache to go. It took a lot of strength out of me, but that's all part of the healing. As time passes, then it comes back and I found walking and gentle exercises the best. Each one of us is different and you would need to go with your surgeon's recovery protocol.

    If you should decide on surgery, then good preparation prior to surgery is a key factor in a successful recovery. The two threads at the top of this section "Post Op Must Haves" and "How Long Will it Take" are essential reading.

    Keep researching and let us know what you decide to do.


    XLIF L2-4 20.8.15
    ALIF L4/5 2009
    Laminectomy/discectomy L4/5 2008
  • my two cents is, why have a major invasive surgery if it is not necessary. i would be concerned if a surgeon performed this surgery on your back if it is not in your best interest. unlike in canada, i'm sure in the US if you ask enough surgeons you'd find a scalpel happy one who would do the surgery for financial reasons. This angers me to no extent!!! AAGGGghhhh! we do not really have that option here in canada, but living here has it's drawbacks as well. it takes a while to get in to see a surgeon for a consultation (sometimes up to 6 months) and then once we do, if surgery is indicated, we could wait months to get the surgery done. this is not to say that there aren't emergent surgeries because there are, i was such a patient in 2005, having surgery within a few days from when i had my surgical consult.

    anyway, back to your situation. enough of the editorialized comments. lol. i can only share with you my experience, and i'm one of these people who have had difficulties like yourself who was told by the surgeon that because there was a tiny distance between the vertebrae a fusion would like occur naturally, which it did eventually. he said there was no nerve impingement, nor any instability so he did not see a need for any surgery at that time. i had previous surgery at that level. he said that the level above the level in question was in good shape and it would be contraindicated to compromise that with surgery which may not be required.

    anyway, that's my two cents. once you go the route of surgical fusions there is not really any turning back. research shows that most people, thankfully, do well after fusions, and that it is a small percentage of people who experience difficulties (about 1 in 5 have significant problems post fusion within 10 years). we gotta remember that on this forum we tend to represent the group that experienced difficulties. we are a very skewed group. too bad there aren't a lot of people on this site who have had fusions with no ensuing significant difficulties.

    since i am droning on and on, i will be quiet now. this is just what i felt compelled to say after reading your post. best of luck to you whatever happens. gotta love grandkids for sure!!
  • I'm having back pain as well - I just went to a physiatrist and we are going to try a very tailored PT program since my pain can be tracked to riding in car, middle of the night and first thing in the am.

    It might be worth a try first before heading in for the surgery. A physiatrist studies muscular/skeletal system and will assess whether he can help you or not.

    If you aren't sure, you might want to try this while you are considering the fusion.
  • Thank you for the responses.

    Babyruth, How long did it take for the disc area to fuse on it's own? Did you have a lot of pain when it was bone on bone?

    DNice, This week I started doing all of the physical therapy exercises my PT gave me back in 2008. I was still doing some of them but not all. It does seem to be helping. I am feeling pretty good right now without taking any pain meds during the day. I only take one ibuprofen at night. It seems to help with the pain I wake up with. Sitting long periods is still a problem but I guess I'll just deal with that.

    I read some online reviews on my surgeon and there are two that are really bad saying he only saw them once at two months after the fusion for an xray and it's been a year now and they both complain that the pain is much worse after fusion now. They said his aftercare is terrible.

    So I have decided to seek out a different surgeon at some point if I need to but for right now I am not going to even go in to see a surgeon since I am doing pretty well. Others have said he is great but just seeing a person once after fusion just doesn't seem right. I know he's very busy with his own practice and a lot of people come and go from his office. Shouldn't there be more then one visit after a fusion even if a person is doing well?

    I did do an online search and found a place in my area with a couple surgeons who have great reviews and apparently they are teaching doctors and the reviews also said the after care is great. So I'll go to that place even though it's not as close as my original surgeon is. That's if I decide to do that. Spontaneous fusion seems like maybe it's the way to go if it doesn't hurt too much to have the disc so thin like that. Which if I just stop doing things to herniate the disc maybe I will do OK. I just have to say that methylprednisolone is an amazing drug. It's been a week since I stopped taking it and I keep improving still a little each day.
  • I started doing the PT I learned after surgery. But, it is worthy re-visiting the PT because for me, I was doing all the right exercises but the initial PT I learned was to stabilize my spine. Turns out, it is very stable but not flexible so all my facet muscle are tight. They are teaching me additional exercises to help me maintain the stability but increase flexibility. I will let you know how it goes. It is the 1st week but they said by week 4 I should start to feel a difference if I do them consistently.
  • I have also read that you get a natural fusion after time. I think the body is very intelligent and tends to heal itself. I think surgery should be the last resort. See your doctor and ask him about the natural fusion. Hope you get better!

  • mchell6789mmchell6789 Posts: 15
    edited 08/24/2012 - 7:24 AM
    Just to add to this. I have not had fusion. I have been watching my grandbaby 4 days a week 6 hours each day and he's up to 18 lbs now. Oddly enough my back has been feeling a lot better since I started carrying him around and picking him up. I can lift him up off of the floor even without any pain. I do it very carefully and squat all the way down and pull him close to me and then stand up using my legs not my back. I can't figure out why I feel better now. The only thing I can think is it's making the muscles in my back stronger. Plus from my most recent MRI there really isn't anything left to herniate out of the disc. So I am at this point going to wait for natural fusion to take place. Unless it gets bad again but so far so good. I've also still been going to the gym and lifting weights and using the exercise ball and I walk and go bike riding. Not long bike rides though anymore. A few miles seems to be fine though and not cause me pain.
  • mchell6789........Sounds like you're doing just fine. "BabyRuth" has a good point about saying that most of the people here have issues and not success stories. I wouldn't be here telling my painfull story if I was feeling great. I would outside playing ball , fishing , or even driving in the car with my kids. I can't do any of that 5 weeks post L5 S1 fusion surgery. I'm in more pain now than before. I couldn't imagine this could happen before surgery. I still have hope that my surgery was, or will be successful. Time will tell. I see my surgeon next week for a check up. He's going to get his ears filled. I've got many questions. He's a great surgeon and a great person,you can tell when people care!
    Here in Canada you sometimes have to wait for a LONG time to see a surgeon. I had to wait 3 years. Then another 6 months for surgery , so for me , I wanted something to happen.....anything .......I thought was better than what i was going through.
    My advice is to not have surgery if you don't have to. I still think surgery, for the most part, does benefit the person......Good luck!


    Different degrees of back pain since 1994
    Cortisone shots Jan/09
    Discectomy and lamenectomy April/09
    L5 - S1 spinal fusion July.13th/12
  • mchell6789 said:
    And what happens when you get to bone on bone
    It HURTS! My L5/S1 is "near bone on bone" according to the discogram CT I just had. I essentially have no disc. Pain in my low back and butt (tailbone area). On occasion it goes into by hip as well. I also have some intermittent tingling that is caused, I think, by spondylitis and spondylothesis. I have a follow up with the neuro surgeon next week because very conservative treatment I have tried has failed. I'm probably looking at a fusion as there seems to be very little success with ADR at that level. I'm not even a candidate because of the spondylothesis. I guess we will see but it doesn't look too promising (to be able to avoid surgery).

    Single level L5/S1 360 fusion with 6 screws and a rod (10/29/12)
    Diagnosis: Grade 1-2 spondylolithesis, Pars Defect, L5/S1 disc tear anterior and posterior, DDD, spinal stenosis
  • My dr showed me the MRI and my L5/S1 is in bad condition and the fusing process has started. Shall I wait and see if I can make it without surgery? I had lamonotomy two years ago and have hurt ever since. I'd like to avoid surgery if possible.
  • I may be one of the lucky ones, but my C6-C7 self-fused uneventfully several years ago. Not quite as lucky though, with the lumbar - when he did my L4-L5-S1 fusion, my surgeon said the L5-S1 was already self-fused to the point that he couldn't separate them to insert a fusion cage, so he removed the remains of the disc, did the foraminotomy and bolted them together in place.
    August 2013 C7-T1 MED
    July 2013 L4-L5-S1 TLIF
    December 2011 C5-C6 ADR
    April 2009 L5-S1 MED
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